In Vitro Fertilisation (IVF)
In vitro fertilization (IVF), the main treatment for infertility, allows for higher rates of pregnancy than natural conception.
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What is in vitro fertilization?
In Vitro Fertilization (IVF) is a technique whereby egg fertilization takes place outside the woman’s body. Embryos are created in the laboratory and then placed in the woman’s uterus to stimulate development and achieve pregnancy. This process involves several steps which need to be adequately coordinated. Designing made-to-measure treatment for the patient's needs, team quality and the clinic's technology are key to success.
In vitro fertilisation
IVF using donated ova
IVF using donated semen
IVF using the patient’s own gametes
Every patient is a unique individual. For this reason, our treatments at Bernabéu Institute are tailored to every one of our patients. Our goal is to locate the source of infertility among couples and select the most effective treatment. The male’s sperm and hormone levels are analyzed and, if necessary, a urological assessment is performed.
In the case of women, their cervical canal and endometrial cavity are examined, as well as possible alterations in their fallopian tubes and their menstrual cycle patterns. These are accompanied by detailed assessments of the couple’s sexual health.
This process ensures that IVF is the correct solution to the patients’ infertility problems and that they are physically and psychologically ready to begin the cycle. If this is not the case, the patients are offered other treatment options.
In order to maximise the possibility of pregnancy, we need to obtain more than one oocyte, which is the number a woman’s ovary normally produces.
In order to stimulate production of several oocytes and guarantee their quality, we administer a combination of pharmaceutical drugs. Response is monitored using vaginal ultrasound scans and timely blood analyses: ovulation induction.
The whole process lasts approximately between 8 and 12 days, depending on each case. The treatment can be cancelled if a low or exaggerated ovarian response is observed.
Once the oocytes are mature, we retrieve them with the guidance of a vaginal ultrasound scan under local anaesthesia and light sedation so that it is a completely painless. This process only takes 15 minutes and does not require an operation, being hospitalised, stitches or the use of general anaesthesia.
The retrieved eggs are taken into the IVF laboratory where they are prepared for insemination.
Oocytes and spermatozoids are placed together for several hours within an incubator which provides the ideal conditions for fertilisation to take place and the subsequent development of pre-embryos. The number of fertilised eggs will not be known until the next day
ICSI (Intracytoplasmic Sperm Injection)
ICSI is performed on oocytes when the reproduction biologist in charge deems it necessary or when it has been previously agreed upon.
The Intracytoplasmic Sperm Injection (ICSI), consists in the introduction of a single spermatozoid inside a mature egg to achieved fecundation.
ICSI proved to be a revolution in assisted reproduction techniques, as it overcomes most male infertility problems. This technique is used in fertilization when sperm suffers from low count, an abnormal morphology, poor motility or when the sperm is unable to fertilize through IVF. It can also be used with patients suffering from a blocked sperm duct. In this case, a puncture is made in order to extract sperm directly from the testicles.
This procedure is performed using a microscope. Micromanipulation equipment is also used, allowing us to stabilize the egg softly and subsequently place the sperm inside it. Sperm selection is essentially guided by morphological features, although other methods (MACS, IMSI, PICSI) can also be used. More information.
Fertilisation is followed by development in a culture medium that provides everything that is needed for growth. The embryos are assessed during development.
Growth is periodically assessed because not all human embryos reach blastocyst stage.
It is important to keep in mind that not all of them will fertilise and become viable embryos. There will be good and poor quality embryos and others that will simply block.
Once the blastocyst stage has been reached, embryo transfer takes place. It is an essential stage during treatment. It entails placing the embryo in the mother's uterus.
The procedure is performed using an abdominal ultrasound scan. The culture medium containing the embryo is positioned inside the uterus. It is a quick and painless procedure.
The environment is a special one that takes into account how delicate the embryo is.
13/14 days after the progesterone medication began, a blood sample is taken from the patient in order to determine if she is pregnant or not. It consists of detecting beta-hCG levels in blood since this hormone is produced by the embryo and passed on to the mother. It is the first measurable sign sent by the embryo.
If the patient is not pregnant, the medical team involved in the course of treatment assesses the causes and decides what steps need to be taken. The patient is given an appointment in order to be able to tell her about the team’s evaluation of the situation.
The main advantages are:
- Much less medication is needed and unlike the classic protocols, not all medication has to be injected.
- Fewer visits to the clinic are required.
- It produces less discomfort and side effects from ovarian stimulation as it is a lot gentler.
It is indicated for:
- Women under 35 years of age with good ovary reserve and good prognosis.
- Previous exaggerated ovarian response that should be avoided.
- Patients at risk of ovarian hyperstimulation.
FIV is a highly flexible procedure. It is possible to use the patient’s eggs or a donor’s. Likewise, it is possible to use your partner’s sperm or a donor’s. This technique has made it possible for women without a partner or with a same-sex partner (Reception of Oocytes from Partner, ROPA) to become pregnant. Furthermore, FIV allows patients to take preimplantation genetic diagnosis and this way reduce dramatically the risk of giving birth to children with genetic disorders.
The advantages and disadvantages of IVF
In vitro fertilisation is the most common type of reproductive medicine treatment. It means ova can be fertilised by spermatozoa outside the woman’s body. Embryos are then transferred in order to facilitate implantation.
- IVF is a versatile procedure. The ova that are used can be sourced from the patient or from a donor. The semen can be the partner’s semen or donor semen.
- The technique has made it possible for single women or women in a same-sex relationship to get pregnant (ROPA).
- It makes it possible to perform pre-implantation genetic diagnosis, a procedure that reduces the risk of giving birth to children with genetic disorders.
- Success rates are high. In patients under 35 years of age, the success rate stands at 76.5% and in patients between 35 and 39 years of age, it is 66.4%.
In terms of disadvantages, it should be pointed out that there is a low risk of complications. These include ovarian hyperstimulation syndrome and multiple pregnancies.
The side effects of IVF
On the whole, patients can return to their daily routine the day after ova extraction or transfer. Rare side effects include slight bloating, increased sensitivity in the patient’s breasts, colic and constipation.
Requirements for IVF
An analysis of the couple is performed and the quality of the male partner’s semen is evaluated. The female partner must also generate ova and be free of abnormalities in the uterus.
IVF success rates
Statistics refer to overall data and should not be extrapolated to any one particular case. It is important to keep in mind that it is essential to always establish a personalised prognosis. The data reflects statistics without PGS (CCS) and elective vitrification.
The cumulative pregnancy rate is indicated below (it refers to pregnancies achieved following the egg retrieval/collection procedure. This includes transfer of fresh embryos and a possible transfer of cryopreserved embryos when the objective is not achieved in the first transfer).
|ACCUMULATIVE PERCENTAGE OF PREGNANCIES ACHIEVED IN A CYLCE OF IN VITRO FERTILISATION (IVF) TREATMENT|
|PATIENTS UNDER 35 YEARS OF AGE*||81,4%|
|PATIENTS BETWEEN 35 AND 39 YEARS OF AGE*||72,4%|
|PATIENTS AGED 40 YEARS OR OVER*||53,9%|
|EMBRYOS THAT REACH THE BLASTOCYST STAGE (5 DAYS OF DEVELOPMENT)**||
|<35 YEARS: 70%|
|IVF CYCLES THAT FREEZE EMBRYOS**||35-39 YEARS: 63,6%|
|≥40 YEARS: 57,1%|